ATR Timeline

And I only realised it was 44 weeks because my timeline said so! Amazing how time flies and how eventually you stop thinking in terms of days, weeks and months post ATR. I can even get up some mornings and not remember straight away!
I’m not long back from a 6.5 week trip to Malaysia and happy to say that I had no problems at all with my leg - and no more DVTs either, yippee. Before I left I had my heart and lungs checkup for the PE and they were all fine. I’ve an ECG at the end of April and if all is good, that should bring this experience to an end hopefully, at 11 months; an "interesting" time!
I can do everyday stuff without any issues now, run up and down steps on tip-toes, etc., without the tendon complaining. In fact, I can feel my calf muscle moaning a bit now, which is great - can’t imagine having thought that this time last year!
Can manage a single heel lift on the bad leg, which is about half the height I can do on my good leg. But I don’t remember having to do many of these in my 50 years, so I could live the next 50 like this
I’ve been pretty slothlike for the last few months - I’d like to say that was because of the PE and severe anemia caused by the anti-coags….yep, that’s my excuse and I’m sticking with it ;-) But now I’m off the anti-coag pills I’ve run out of excuses and so I’m going to have to start some gradual, routine exercise again. Good time of the year to start
I pop in here every so often to see how everyone else is progressing. I saw Kellygirl was around not so long ago - great posts as always :-) Glad to hear all the people who were suffering along with me are doing well too. This site is such a help, only those who have gone through an ATR (or 2, NormOfTheNorth) can understand the frustration; it kept me sane. There were times when I felt I’d never be "normal" again (whatever that is!).
And so today I find out if I can stop the iron tablets too. Woohoo!

Just back from the physio (a new one - good to have a 2nd opinion). She was very happy with my progress, which I have to say, so am I. Just this last 2-3 weeks things seem to have started to come together (excuse the pun).
I can walk most days without a limp and no pain. I can feel my calf muscle working and today the physio got me to do bi-lateral heel raises and then a uni-lateral. She was very pleased with the bi-laterals and happy with the uni-lateral, but obviously needs more work on the calf muscle.
I’m ecstatic - I’m not sure I ever did uni-lateral heel raises before but good to know I can sort of do one now Next step is a lower-limb rehab class - a sort of circuit of exercises with a physio watching over me.
I still have two different coloured legs - from the DVT I think, but that’s ok; kind of quirky Finally, I feel that the worst might be over.

… or so it seems sometimes. I’ve been travelling Northern Spain for the last 5 weeks and just before I went, I really hurt my tendon at physio. I had a lot of pain and so decided to ease off on the exercises and just do stretches so long as it was bearable. It took about 3 weeks until I was back to where I had been! Was doing well on holiday until last week, when I overdid trying to walk normally and I’m back with the inflamed, swollen tendon again So I’m back to resting it as much as poss.

My doesn’t time fly when you have use of all your limbs!
I’ve had 3 physio session - 1 a week since I last updated. I’ve officially ditched the boot and crutches - I say officially, because I had really anyway, but it was good to get the ok from the physio.
I can walk barefooted around the house and outside, I’m in shoes with a heel of about 1.5-2cm. Still have a limp when I walk outside but not so much when I’m in the house - must be a speed thing or a length of stride. I’m trying very hard to put equal weight on both legs and not fall into the habit of limping.
Around my ankle still swells badly and that does affect the movement I have, but the physio measured my ROM and there’s a 5 degree difference in my bad leg in the dorsiflexion and 25 degrees in the plantarflexion, which she says should get better but wouldn’t be too much of a hindrance if it didn’t. I’ve got 1cm difference in calf size. She was pleased with my progress.
I’ve been using my exercise bike in the last couple of days - she said it would be fine (I worry more about my heart and lungs after the DVT/clot). I’m taking things easy on that front.
I’ve got a new toy - a wobble/balance board. Thought it was it too easy…until I closed my eyes! Quite good fun and I can feel everything working to keep that balance.
I’ve other exercises to do to strengthen my calf muscles and to loosen the tendon (heels hanging over a step and lowering from my toes slowly, etc) and she suggested walking uphill and on uneven surfaces too. I can go upstairs on alternate steps, but not down.
I’ve had a couple of moments when my heart and the World stopped - one where going upstairs, I forgot I had an injury (how brilliant is that!) and just put my toes on the step instead of my whole foot. My ankle gave way thankfully and not my tendon…scarey. I must remember to concentrate at all times.
I can cook, clean, drive - who would think that would be exciting! I’m guessing the novelty will wear off soon So I feel like I’ve turned a huge corner from the bleak, dark days of not so long ago, when it felt like I would never live a normal life again. A bit melodramatic, I know, but you feel what you feel.

I’ve managed to walk, without crutches, in 2 shoes and I’m so happy. There’s a long way to go with the walking style but I’m seeing the physiotherapist on Monday. I will still be wearing my boot outside though.

I kind of knew I should stop trusting what NHS staff say to me, but I hoped that when the consultant told me I was an urgent physio case and someone would phone me in 1-2 days about seeing a physiotherapist, that it would happen that way.
However, it didn’t, and so after chasing down where I’d been referred to (hurrah! my local hospital, 5 mins drive away instead of 50 mins!), the first available appointment was the 5th August. So it’s taken 10 weeks from my injury to see a physio and officially start exercising my leg. I shall continue to do my own thing until then I guess :-/

So, where to start. Not long after my last post, I ended up in hospital with a pulmonary embolism, caused by a DVT in my injured leg.
I’m feeling much better now - angry that this could happen but it just confirms my feelings about my particular NHS care.
Back to the fracture clinic tomorrow for my 3rd visit, with absolutely no idea what they have in mind for me, but I’m not holding my breath with anticipation of an improvement in the service.

So I had my cast removed on Tuesday (4 weeks after ATR). I had to ask for a doctor to examine my tendon, they were just putting me straight into a boot. The doctor felt my ankle area and claimed the tendon was intact. I’m hoping he’s right but I wasn’t going to get a scan out of them.
I’m in a very, very heavy boot (NHS style) with wedges. To be kept on at all times - sleeping was disturbed again the first couple of nights. I’d gotten used to the cast!
They reduced the angle that my toes were pointing down and I’ve to take another wedge out in 2 weeks time, returning to the hospital in 4 weeks. The doctor said that they would be organising physio at my next visit - I think that meant getting organised then, rather than doing physio then! Still not to put any weight on that leg although they said I could gently rest that foot down for help with balance.
I’m not feeling very confident and I’m terrified I re-rupture the tendon or that it actually hasn’t rejoined. When the cast was off I had a very shakey leg and foot that had no movement capability - I hope that is normal. My tendon area was very tender when the doctor was examining (prodding!), but I’m not aware of any pain at any other time.
I don’t have much discomfort and I can wiggle my toes and push down (not weight bearing) through my foot, which I try to do to keep circulation moving. I still keep my leg raised when I’m sitting, which seems a lot of the time. My arms are aching with the extra weight of the boot - thought I’d got used to the crutching.
It’s hard to put trust in other people when I feel so much is at stake but the UK NHS is not open to patients taking control of their treatment, so I’m going to have to.

So I got to almost 50 and then bang (or pop is maybe more like it!). I wouldn’t describe myself as a keep-fit fanatic, but I’ve always tried to be active and recognising old age symptoms creeping up on me, I decided about 4 years ago to take up a regular class at my local gym. On Monday evening, a week ago today, as I was running I felt and heard a pop or snap and the ground beneath my left foot just disappeared as if there was a hole under it, or the heel of my trainer had broken. Next thing I was on the ground; trainer intact and no holes, so I knew there was another, less simple explanation.
My trainer suspected I’d damaged my achilles tendon but hoped it was just a strain, so I didn’t put any weight on that leg, kept it raised and put an ice pack on it. The next morning I hopped into see my GP who did the Simmons/Thomson test and declared I’d ruptured my achilles tendon and sent me with a letter to the A&E. They repeated the tests and agreed (no scans) and said they tend to treat ATRs conservatively (for my age and activity) and stuck my leg in plaster from knee to toes with toes pointing down.
I’ve to be in cast for 4 weeks (1 down, 3 to go!) and then if all looks well, I’ll be in a WB for another 4 weeks with various wedges, I’m not sure at what point I start to put weight on that leg. Then physio for weeks after. If not all going well, then it sounded like an operation was the next step. I’m hoping that because I didn’t put any weight on my leg at any time after it happened and kept my foot raised as much as possible that I’ve not made things worse. We’ve booked to go to Malaysia at the end of September and the orthopedic doctor was very non-commital if that would be possible or not.
I’ve never really had any pain - the back of my leg ached severely for about 10 mins after it happened and for about an hour. I do have a lot of twinges, which is weird but not unpleasant. My hands are aching from crutching - they gave me the wrist type, not underarm ones and so I’ve been using my weight training gloves which helps. Shoulders were sore, but they’re ok now. My hip on my damaged leg hurts if I crutch too much as it’s taking the dead weight, so I try not to do too much.
My biggest worry (apart from boredom!) is how much moving around I can do without causing any more damage. I can’t help feeling that I’m tensing my calf muscle when I crutch and I’m sure that can’t be a good thing to do? Can anybody advise me on this please?
Not looking forward to the next 3 weeks! Ironically, I retire from work in 2 weeks time! I’ve never had more than a week off any job before and then this happens.

Recent Comments

Hi Norm and Hillie
I was “treated” (open to debate how well that was ) at Paisley rather than Glasgow - although they are very close geographically, so I wasn’t treated by Wallace and I couldn’t say if he is/was at Glasgow or Belfast. Sounds like I would have been better of if I had seen him!
However, as I am now whole again and on the mend, I can say, that it can always be worse!
I might just buy that lottery ticket anyway

Pam, I just twigged on “Glasgow”, just as a few of us have been discussing the Glasgow study of almost 1000 non-op ATRs treated by the same senior OS (Wallace?). Were you part of that now famous group?
I think his paper shows how unusual you were to get the clots (DVT & PE). Time to buy a lottery ticket?

My feet (more than legs) have been different colors for many years. Left one darker-redder. Pre-ATR#1, I think. Whenever I mention it to an MD they look at me as if I’m the Leader of the Worried Well… so I’ve stopped.

Good news there Pam with regard to the heel raises, when I started being able to do a single heel raise it was only tiny, and seemed to make no progress, but a month down the line it started making good progress and higher lifts.
Your different coloured legs may not be the DVT, my bad leg was still darker at your stage, although I’m fairly sure its sorted now (8months).
Enjoy the lower limb gym, it was my life saver!

YAY!! Keep working it, but don’t go nuts — and don’t assume that everything a PT tells you to do is safe, either! I had a 1-month setback from doing whAt
My PT told me to do, post-op at about your stage of recovery. Stay incremental, and give your leg hours or even a day or 2 to “digest” any big “steps”. It won’t slow you down much compared to a big setback.

Am empathetic with your ‘1 forward and 3 back’. It is definitely a challenge this ATR recovery. This site is really good even at this stage as friends and family I think must be pretty tired of the ATR recovery woes/success’. Takes a fellow sufferer to understand. Hang in there - full recovery is in sight!

Ya, going FORWARDS is frustrating ENOUGH!!
I lost a month from a dumb PT after my first ATR. (Her patient wasn’t too smart either! ) Even after the risk of rerupture is gone, it’s best — and hard — to know where to draw the line. Some people seem to do pretty well “pushing through the pain” and using body-builder techniques to rebuild the calf and surrounding muscles and tissues. And some suffer setbacks and have to back off and let things heal.

When the newest and best evidence on ATR rehab generally shows that the fastest common rehab protocols — like bit.ly/UWOProtocol and the new Exeter protocol — work the best, it’s tempting to just keep going faster and faster, doing more and more. But it’s still a balancing act, and being incremental is still the best policy, maybe for close to a year — or until you can really start forgetting your ATR!

thanks Kelly, it’s times like these that you really appreciate a website like this that allows you to moan and groan and get support from fellow sufferers. I don’t believe that anyone who hasn’t been through this injury can really appreciate how frustrating it is. You look like you’re progressing well

I can sympathize. I had a lot of forward/backwards progress and still do at times. It’s hard to be incremental. Hang in there though–I’m noticing that recovery takes less time the further along I am in the healing process.

Hi lovely to hear how you are progressing as you are similar time to me, I ruptured on 4th June, surgery on 13th. I am walking in two shoes, finding I still have quite a limp when walking outside, am doing all the exercises given by physio but feel its all quite slow! Taking one day at a time seems to be the moto of the last few months!

I fear the cook, clean and drive does get a bit old after awhile Sounds like you are doing great. The ROM definitely improves over time. That’s great that you only have a 1 cm difference between calves. Mine is twice that. Good luck with the rest of your recovery. Thanks for the update!

@Loumar747 - Thanks for your support. I totally get the “trust” and re-rupture thing; particularly the re-rupture, which is never far from my thoughts. My physio, this week suggested I try a heel drop on my injured leg on its own - I had to refuse that one, which she was ok with (and she does say I should listen to my body).
But I can see that things are improving and I’m back in control (ish) which is good enough for me

I definitely do know how you feel. Did my first ‘heel drop’ at physio yesterday. When the physio explained the exercise, I was horrified at the thought and said, “Are you sure?” She assured me that it would be okay and that now part of the healing process is building trust. That darn fear of re-rupture is always lurking just below the surface!! Sounds as though you are doing well. Keep up the good work and I’m really glad that you’ve turned the corner from those bleak, dark days!!!!

If you haven’t found bit.ly/UWOProtocol yet, go find it and print it out. And the protocols we discussed on sudsy’s site recently, too. And catch up gradually. And DON’T go slower to lower your rerupture risk, because the evidence is clear that it does the OPPOSITE.

And thank you Norm for drawing my attention to the myth of aspirin preventing DVTs! Who would have known, given all the advice to take low dose aspirin before long-haul flights. I had no idea that it was only any use in preventing arterial clots, not venous. Sad that I had to go through the experience to learn this, lol!

Stay close to a good proven protocol. If you’re behind, catch up gradually, but do it. If you do remove wedges gradually, do it at bedtime and sleep in the boot, to separate the ankle-angle change (stretch) from the WB loading.

It’s always frustrating to get bad service, and getting it from health pros is the worst, but it happens a lot. The Yanks pay top dollar for their medicine, and many studies (and our informal ATR survey here) suggest their not getting consistently excellent care either. Way too much random (& non-random) variation. Different systems produce different problems. I lucked out with my ATRs in Ontario, but some of my neighbours got less impressive care.

I’m 8 weeks post injury so 2 weeks ahead of you but two week behind! I was told still not to put any weight at all on the injured leg at my week 4 appointment - and my next appointment was at week 8.

I have been ignoring this since about week 5 because I worried about the lack of moving and DVTs (ha!).

I’ve been gradually increasing the amount of weight, but very carefully and maybe too carefully, but I’ve no intention of putting myself at the mercy of the NHS again through a re-rupture.

On Tuesday (my week 8), the consultant told me to start putting weight on it in my bare feet - not possible atm and I’m not pushing that one. I’ve taken another wedge out - I was told to take one out at week 6 but no further instruction.

And you’re right, we have paid for this rubbish service through our taxes and NI - sadly I’ve been paying longer than you I think it’s more the disappointment when you’re led to believe something will happen within a certain time-frame and then treated as if you are unreasonable when you question why it didn’t, as happened to me today by a receptionist; not medical staff.

I share your frustration! I was told I would have an ‘urgent’ appt made for me on my last visit. I got the distinct feeling that they had ‘forgotten’ the PT schedule.
I know our NHS service is supposedly free, but when you’ve paid taxes and National Insurance contributions for 23 years - the free bit sounds bit hollow.
Don’t rush your own exercises, I’m sure you know your limits.

I was told to FWB 3 days ago. (6wk post op) I’m hobbling, but feel liberated!

Aspirin works in a very different way than the so-called “blood thinners”, and the two groups don’t necessarily prevent or minimize or break up the same clots. I know only enough about it to know that it’s not simple.
It’s pretty remarkable how well Warfarin works in huge groups of heart patients who are at risk of clots — ESPECIALLY when it’s combined with home- or self-monitoring for blood (”INR”) levels.

All the studies show WAY better outcomes with self-monitoring, vs. the standard periodic visits to a clinic (with arbitrary nuisance visit schedule and delayed reporting). And self-monitoring ends up costing the system much less than the clinics and labs — but it runs afoul of an entrenched establishment, and it’s not the way today’s doctors were trained. (Sound familiar?)

No, I’m guessing they wouldn’t use it over here as a preventative for ATR even if it was effective because of the cost to the NHS. In my case it’s being used as an anti-coagulant, but I know that it can be used for prevention of strokes caused by clots in atrial fibrillation. However, my mum is a sufferer of AF and she wasn’t offered it, but instead put on Warfarin, so not sure who would be prescribed it for this condition.
Good old low-dose aspirin might have been a reasonable preventative in my case I guess.

Pam, because of my OTHER online fetish — heart health, since I had a heart valve replaced — I get notices of lots of articles on trials for Rivaroxaban and other Warfarin alternatives. But I generally don’t read them — and none of them is about using them to prevent DVT after ATRs, either!

I was on heparin injected into my stomach (ouch) in hospital but now I’m on a newly licensed drug (in the UK at least) called Rivaroxaban (Xarelto, elsewhere). It’s only licensed for short term use here, which is fine for me as I’ve only to be on it for 6 months.
15mg twice daily for 21 days and then 20mg once a day for the remainder.
The benefit of this drug over Warfarin is that I don’t have to have the frequent clotting-time tests to adjust the drug level. It is more expensive than the rat poison option of course, but I think I deserve it

I don’t blame you for being slow to treat it seriously, and I’m impressed that you basically got the diagnosis right!

Are you doing daily Heparin shots, or what?

I forget exactly how much lower the frequency of DVT was, non-op than post-op, in the latest meta-study. I recall that it was very significantly less frequent, but when it happens to you, that’s cold comfort. (Mathematicians will tell you that when the event either DOES or DOES NOT happen, “the probability function collapses”, from whatever the risk was in advance, to 0 or 100%. Great!)

Yes, sorry, that would have been most useful for me to have described the symptoms. My brain hasn’t recovered!

So about a week before I went into hospital (week 5), I had a “funny turn” where I got up from lying down (trying to tune a remote to a TV in our motorhome - which I never did!) and I felt really breathless and had a slight irritation in my chest - like I wanted to cough, but mostly it was just irritating. I sat down and started to feel really lightheaded as if I was going to pass out - hearing and sight felt weird and I felt hot and uncomfortable, etc. My husband was with me and said I went very pale.

I put it down to low blood sugar or postural hypotension - getting up suddenly, you know and age, etc. But I felt ok after a night’s sleep. Little did I realise that what I’d experienced was my first pulmonary embolism!

As far as the DVT goes, I had had some aches, but none in my calf and they nothing unbearable. I put it down to lack of use of that leg. The worst ache I had was at the back of my knee and above, after travelling in the car for about 30 minutes (the day of my son’s graduation,

Hi Micah et al,
thanks for your kind words. It was very scarey and although I was aware a DVT was a risk (from my own research), I stupidly put my trust in professionals, thinking that if they didn’t think it (I) was a risk because there was no mention of it, then it must be ok, particularly as I was non-op, not overweight, don’t and never have smoked, not on any medication, etc. I considered all other possible options before I finally decided I was out of them and it was time to got to the hospital.

I have had NO assessment other than the Thompson test for the ATR. I was left sitting with my leg hanging off a wheelchair for at least an hour before it was put in plaster, given a pair of crutches, told no weight bearing, and shown the door. No questions about my life style, varicose veins (I have none that I know of) or family history. No warning or advice on what to look out for. Perhaps a low dose aspirin daily and a leaflet describing the symptoms to watch for would have been a good idea.

As far as the doctors in the cardiac unit were concerned, it was totally caused by the fact I wasn’t moving that part of my leg. B

Hi Pam, Sorry to hear that you had a PE, it must have been a scary experience and feels so unfair after also having a ruptured achilles. I was also no op on the NHS and I was assessed fro my thrombosis risk, as in I was asked questions like was there any family history ofDVT or PE, have I had any clotting disorders, did I smoke, any significant varicose veins, age (50 not a risk apparently) and they assessed me as not at risk, so I did not get offered any blood thinning injections. It didn’t stop me being paranoid about getting a DVT though, but I was fortunate. Do you think you were assessed? Would it be worth finding out at your next appointment to set your mind at rest that nothing else could have been done? None of us can turn back the clock, but sometimes knowing that it was just bad luck can help to deal with it. best of luck Pam .

I’m sorry that you have had to deal with a clot. I didn’t even know it was possible without surgery (shows how much I know!) How long has it set you back? Are you weight bearing at this point? Hope that your appointment goes well tomorrow. Good luck!

Good luck! Those nasty clots are much rarer among the non-op crowd than the post-op patients, but they’re always possible with a big trauma and massive healing. Some docs prescribe Heparin shots to avoid clotting, but that’s rare. Very few patients get these particular complications, but if you’re one of those few, that’s obviously little help.

What is clear from the non-op evidence is that the results are essentially identical to post-op IF you go with a fast modern protocol. The results from old slow “conservative casting” are quite inferior, especially in much higher rerupture rates. So don’t let them lead you down the slow path!

I agree re the very different treatment in the NHS dependent on where you live. I am non surgery and I decided that I wanted to go into a Vacoped boot so I bought one on Ebay and took it along to my NHS hospital (Derriford in Plymouth) at my 2 week appointment. They were only too happy to let me go into it instead of their standard issue Aircast. They told me that they would like to give all of their patients Vaco boots but that they couldn’t afford to switch.
I have not had a scan either but the doctors think that my rupture is pretty high up. As a result they put my boot into a fixed poition of 15 degrees and said that I could FWB. 3 days afterwards I stopped using my crutches (I bought an Evenup for my other shoe to equalise my height with the boot). After 4 weeks I went back and they put the boot at 0 degrees - 10 degrees. The Vacoped boot is hinged and allows a variable setting. I have been moving the setting by 5 degrees each week and I am now at 0 - 20 degrees. I should be getting into 2 shoes by week 8 but I am on holiday so have put that back to week 9.
My experiences with the boot have been good. It is very easy to clean

Most times you simply don’t need a scan - I had one to confirm the initial diagnosis, but none during my recovery period. The doctors and physio’s can tell if it is coming together ok.

As for your boot, you’ll be delighted to know that these days, there isn’t really an NHS type! The difference is down to the individual trusts, their budgets, and the knowledge base to enable them to move forward, utilising the latest technologies and treatments. My boot was a Vaco boot which weighed about 6 pounds (2.8kg), and can now be found in an increasing number of NHS hospitals. Every part can be washed or cleaned easily, and can be worn in the pool (check out YouTube).

What are you proposing to do to ‘take control’? Do you have copies of the latest protocols? Check out this blog for UWO, and posts this week from Suddsy and me regarding even more recent stuff, and results from Exeter.

If you’re going to challenge the regime you need the ammunition. Raised voices and no evidence will achieve nothing as I’m sure you are already aware.

Also obtain a written protocol from your hospital and try to establish a relationship with

Hi, I agree with Musimaster. I had a complete rupture of my tendon and when I came out of the cast my leg was very weak. So, dont worry because once you go to the boot you will be able to really exercise your foot more and gain strength in you leg. You may be surprised of how quickly you gain strength back in you leg. I am at week 5.

thanks ripraproar, I know you’re right about the mind being the biggest factor and of course everyone heals at different speeds. I’d love to be in shoes in 3 weeks time or sometime soon after that. I suppose it’s the lack of information about the hospital plan that doesn’t help.

Pam all your feelings about re rupture tendon not healing 99 percent of us go thru the same thing, I think the mind is the biggest issue with this injury, I went private and didn’t get scans etc, was in breg boot very heavy
8 weeks in shoes is the normal